Prepregnancy obesity prevalence in the United States, 2004-2005.
ABSTRACT To provide a current estimate of the prevalence of prepregnancy obesity in the United States.
We analyzed 2004-2005 data from 26 states and New York City (n = 75,403 women) participating in the Pregnancy Risk Assessment Monitoring System, an ongoing, population-based surveillance system that collects information on maternal behaviors associated with pregnancy. Information was obtained from questionnaires self-administered after delivery or from linked birth certificates; prepregnancy body mass index was based on self-reported weight and height. Data were weighted to provide representative estimates of all women delivering a live birth in each particular state.
In this study, about one in five women who delivered were obese; in some state, race/ethnicity, and Medicaid status subgroups, the prevalence was as high as one-third. State-specific prevalence varied widely and ranged from 13.9 to 25.1%. Black women had an obesity prevalence about 70% higher than white and Hispanic women (black: 29.1%; white: 17.4%; Hispanic: 17.4%); however, these race-specific rates varied notably by location. Obesity prevalence was 50% higher among women whose delivery was paid for by Medicaid than by other means (e.g., private insurance, cash, HMO).
This prevalence makes maternal obesity and its resulting maternal morbidities (e.g., gestational diabetes mellitus) a common risk factor for a complicated pregnancy.
SourceAvailable from: Zachary M Ferraro[Show abstract] [Hide abstract]
ABSTRACT: Objective. To determine a precise estimate for the contribution of maternal obesity to macrosomia. Data Sources. The search strategy included database searches in 2011 of PubMed, Medline (In-Process & Other Non-Indexed Citations and Ovid Medline, 1950-2011), and EMBASE Classic + EMBASE. Appropriate search terms were used for each database. Reference lists of retrieved articles and review articles were cross-referenced. Methods of Study Selection. All studies that examined the relationship between maternal obesity (BMI ≥30 kg/m(2)) (pregravid or at 1st prenatal visit) and fetal macrosomia (birth weight ≥4000 g, ≥4500 g, or ≥90th percentile) were considered for inclusion. Tabulation, Integration, and Results. Data regarding the outcomes of interest and study quality were independently extracted by two reviewers. Results from the meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birth weight ≥ 4000 g (OR 2.17, 95% CI 1.92, 2.45), birth weight ≥4500 g (OR 2.77,95% CI 2.22, 3.45), and birth weight ≥90% ile for gestational age (OR 2.42, 95% CI 2.16, 2.72). Conclusion. Maternal obesity appears to play a significant role in the development of fetal overgrowth. There is a critical need for effective personal and public health initiatives designed to decrease prepregnancy weight and optimize gestational weight gain.BioMed Research International 01/2014; 2014:640291. DOI:10.1155/2014/640291 · 2.71 Impact Factor
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ABSTRACT: Background We conducted a nested randomised trial to evaluate the effect of an educational DVD, providing information about healthy food choices and exercise during pregnancy, on diet and physical activity, among pregnant women who were overweight or obese.Methods We conducted a nested randomised trial within the context of the LIMIT randomised trial. Women were eligible with a singleton pregnancy between 10 and 20 weeks gestation, and body mass index at the time of their first antenatal appointment of ¿25 kg/m2. All women who were randomised to the Lifestyle Advice Group of the LIMIT trial received a series of consultations with both research dieticians and research assistants, in addition to standard written dietary and exercise materials (Standard Materials Group). Women randomised to the DVD Group received the same consultations and written materials, and additionally received an educational DVD (DVD Group). The primary study outcome was the Healthy Eating Index. Other study outcomes included physical activity, and gestational weight gain. Women completed a qualitative evaluation of all the materials provided.Results1,108 women in the LIMIT Lifestyle Advice Group participated in the nested trial, with 543 women randomised to the DVD Group, and 565 women to the Standard Materials Group. Women who received the DVD compared with those who did not, had a higher mean Healthy Eating Index at 36 weeks gestation (73.6 vs 72.3; adjusted mean difference 1.2; 95% CI 0.2 to 2.3; p¿=¿0.02), but not at 28 weeks gestation (73.2 vs 73.5; adjusted mean difference ¿0.1; 95% CI ¿1.1 to 0.9; p¿=¿0.82). There were no statistically significant differences in physical activity or total gestational weight gain. While most women evaluated the materials positively, frequency of utilisation was poor.Conclusions Ongoing attention to the delivery of information is required, particularly with the increased use and availability of digital and multi-media interactive technologies.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12607000161426.BMC Pregnancy and Childbirth 12/2014; 14(1):409. DOI:10.1186/s12884-014-0409-8 · 2.15 Impact Factor
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ABSTRACT: Diabetes mellitus (DM) is one of the most common medical conditions to complicate pregnancy. This protean disorder of metabolism is associated with varieties of risks to the woman and to the developing fetus.1,2 In the context of pregnancy, DM may be regarded as “pregestational” when the metabolic abnormality antedates pregnancy or “gestational” when it manifests during pregnancy. Gestational diabetes mellitus (GDM) is defined as hyperglycemia of variable severity with onset or first recognition during the current pregnancy.3 Appearance of many hormones, such as human placental growth hormone (hPGH), human placental lactogen (hPL), estrogen, progesterone, prolactin, cortisol, and tumor necrosis factor-alpha (TNF-α) particularly during late pregnancy— antagonizes the effects of insulin, triggering a state of insulin resistance (IR), thereby increasing insulin requirements. These changes in the hormonal milieu, along with the manifestation of subclinical inflammation create a diabetogenic environment in the pregnant mother and induce IR.4,5 Exaggeration of the state of IR in a pregnant woman ultimately manifests as GDM. Thus, GDM is a result of both pancreatic b-cell insufficiency and increased IR, although genetic factors and other processes might also be involved. Once thought a transient condition, GDM proves to be of greater concern for both mother and child for adverse effects not only during pregnancy, but also in the postpartum period and beyond.6 Women with previous GDM are at increased risk of developing type 2 DM (T2DM) in their later life.5,7 Long-term follow-up studies indicate a conversion rate of GDM to T2DM between 10% and 50%.7 Studies have shown that GDM also increases the risk of long-term development of hypertension and dyslipidemia and, therefore, also atherosclerosis and coronary artery disease.8,Contemporary Topics in Gestetional Diabetes Mellitus, Edited by V.Seshiah, 01/2014: chapter Gestational Diabetes Mellitus and Metabolic Syndrome: pages 212 -221; Jaypee Brothers Medical Publishers Private Limited., ISBN: 978-93-5152-372-7